Definition and Overview

Sinus disease or sinusitis is one of the most common health problems in the United States. It leads to over 15 million GP appointments and no less than $140 million spending on medications alone.

Sinusitis is the inflammation of the sinuses, which are tiny air-filled sacs that are found in different areas of the skull: frontal (lower part of the forehead), maxillary (cheekbones), sphenoid (back of the nasal cavity), and ethmoid (in the middle of the nasal bridge and the eyes). These four pairs are considered to be paranasal sinuses.

Although sinuses play a key role in enhancing the quality of our voice, their main purpose is to create mucus in the nose to trap allergens, germs, and other infectious agents that can threaten a person’s overall health. With the help of cilia, which are very small hair-like structures, the mucus, with the trapped agents, is pushed down into the throat and goes through the stomach until it is eliminated the natural way. This normal process is so subtle a person almost always doesn’t notice it.

In a case of sinusitis, a certain cause, which can range from a congenital defect to a virus or bacteria, leads to the inflammation of the sinus. It then creates very thick mucus, which prevents the cilia from moving it towards the throat.

Sinusitis has many different types usually based on its duration:

  • Acute – Acute sinusitis happens suddenly, but it also doesn’t last very long. In fact, the inflammation usually goes away on its own, or basic medications like antibiotics can already resolve the problem.

  • Sub-acute – Sinusitis is considered sub-acute if it lasts for more than 3 weeks but no more than 12 weeks.

  • Chronic – When a person develops sinusitis for no less than 3 months, it is already described as chronic. Despite the sinusitis lasting this long, the condition is often not severe.

  • Contagious – Sinusitis is generally not contagious, even if it’s caused by bacteria. However, if the problem is due to a virus, such as that of a common cold or flu, the condition becomes highly contagious and may be passed on normally by hand-to-hand contact.

Causes of the Condition

Inflammation of the sinuses can be caused by any of the following:

  • Congenital defects – Any bone deformity within the nasal cavity, as well as a deviated septum, can cause blockage of the sinuses.

  • Viral – A common cold affects the nasal passage, but because the sinuses are also near, it’s possible for the virus to travel and affect the air-filled sacs. A viral sinusitis usually lasts longer than a common cold. A virus that causes the flu can also be a culprit.

  • Dental infection – Bacteria can lodge in many areas of the mouth, including the teeth and the gums. When they are not immediately treated, they can lead to inflammation, which can spread to the maxillary sinuses.

  • Allergic rhinitis – Many people tend to confuse sinusitis and rhinitis since they both involve the thickening of the mucus. Rhinitis is an allergic reaction to pollen, dander, and dust, among others, that causes irritation to the nose. When the nose becomes irritated, it is forced to create more mucus. When this thick mucus is pushed toward the throat, the throat also becomes irritated, which forces a person to cough.

Nevertheless, since it’s common for rhinitis to happen alongside sinusitis, the latter is sometimes referred to as rhinosinusitis.

  • Nasal Polyps – Polyps are small overgrowths inside the nose. They are caused by many factors including mucus. When the mucus becomes so thick, it sometimes forms into balls, which become polyps.

  • Cystic fibrosis – This is a disease characterized by the thickening of the mucus in many parts of the body such as the lungs and nasal cavities. Mucus thickening doesn’t only impede proper breathing but also prevents mucus from trapping organisms that can cause infection.

  • Compromised immune system – People with a very weak immune system such as those diagnosed with HIV or are being treated with chemotherapy can develop sinusitis easily since they are more prone to infection.

  • Injuries to the face – Trauma to the face including the cheeks and the nose can change the internal physical structure, which can block the sinuses.

Key Symptoms

  • Facial tenderness
  • Redness of the face
  • Green nasal or thick mucus discharge
  • Post-nasal drip (which can be felt when thick mucus passes through the throat)
  • Fever
  • Cough
  • Pain in parts of the face where the sinuses can be found
  • Dull headache accompanied by throbbing pain on the face

Who to See and Treatments Available

A GP can already assist a person with sinusitis. First, he performs a physical examination, including taking temperatures, feeling the face, or looking for physical signs such as redness or green nasal discharge. He may also look into the medical history, especially if the person has already been diagnosed with flu or a cold before the symptoms of sinusitis appeared.

He may also use a small flashlight to look into the sinuses. If they’re difficult to see, he may insert an endoscope, a small flexible tube with a light and camera tip so he can see the internal conditions of the nasal cavity through a monitor.

Depending on the diagnosis, medications can be provided. If after the treatment plan is over and the sinusitis remains or has gotten worse, the GP may recommend the patient to an ENT (eyes, nose, throat) doctor for further evaluation. An ENT specialist may request for imaging tests such as CT scan.

Treatments for sinusitis include:

  • Decongestant sprays, which are recommended for acute sinusitis; they should never be used for more than a week
  • Antibiotics if the sinusitis is caused by bacteria
  • Saline solutions to remove thick mucus
  • Antihistamines, particularly if sinusitis develops with rhinitis
  • Surgery if the cause is a congenital defect

It may also be prevented by:

  • Frequent hand washing
  • Use of hand disinfectant
  • Flu vaccination
    References:

  • O'Handley, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 19.

  • Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for management of acute bacterial sinusitis in children 1 to 18 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006.

  • Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012; 54:e72-e112.

  • Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1-S31.

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